Provider Demographics
NPI:1114222197
Name:MARKS, LISA (LISA MARKS CRNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:LISA MARKS CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 S 6TH ST APT 1803
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3734
Mailing Address - Country:US
Mailing Address - Phone:215-925-2480
Mailing Address - Fax:
Practice Address - Street 1:241 S 6TH ST APT 1803
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3734
Practice Address - Country:US
Practice Address - Phone:215-925-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011122363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health